BENNETT W NELSON OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047931078

License Status

NOT RENEWED

Business

Title

First Name

BENNETT

Middle

Last Name

NELSON

Business Name

BENNETT W NELSON OD

Original Issue Date

04/18/2005

Effective Date

04/18/2005

Expiration Date

03/31/2006

City

CHICAGO

State

Zip

60610

County

COOK

Ever Disciplined

LastModifiedDate

05/11/2006